Electrosurgical element and uterine manipulator for total laparoscopic hysterectomy

ABSTRACT

A vaginal cervical retractor used to maneuver and visualize the uterus during various medical examinations and procedures would include an inner tube provided with a movable assembly of plastic cups (cervical cup and vaginal cup) designed to be inserted into the uterine cavity and a retractable electrosurgical needle. A cervical cup is molded to a hollow outer shaft to form the movable cup assembly. This hollow shaft is provided through which the inner tube can be inserted. By utilizing a vaginal cervical retractor elevator provided with an inner rigid tubing, freely sliding vaginal cup and cervical cup designed to move on the inner tubing, attached to a hollow, plastic outer shaft into which the inner tubing can be inserted, and a retractable, flexible, electrosurgical needle, the colpotomy procedure can be performed with the improved uterine manipulator.

TECHNICAL FIELD

The present invention relates generally the field of surgical devices,and more particularly the invention relates to an improvement to auterine manipulator device used for total laparoscopic hysterectomyprocedures.

BACKGROUND ART

Various surgical procedures that are performed on women require that thewomen's uterus be manipulated such that the physician can view theuterus and cervix properly. Typical of these examinations and procedureswould be a complete total laparoscopic hysterectomy, a partiallaparoscopic hysterectomy, a colpotomy, as well as other procedures andexaminations. Generally, during the performance of a laparoscopicprocedure, a small incision is made in the wall of the abdomen and alaparoscope is inserted therethrough to permit visualization of theperitoneal cavity and the uterus.

According to multiple published reports, more than 600,000hysterectomies are performed annually in the United States alone.Conventional hysterectomy surgical procedures typically involve one offour approaches—vaginal hysterectomy (VH), total abdominal hysterectomy(TAH), total laparoscopic hysterectomy (TLH), and laparoscopicallyassisted vaginal hysterectomy (LAVH). Vaginal, LAVH, and TLH have becomemore popular among surgeons because these approaches are less invasivethan TAH, with VH being the least invasive approach. Close to 12% ofthose surgeries are done by a minimally invasive approach orlaparoscopically, translating this into more than 70,000 surgeriesannually in the United States, alone. VH is considered the leastinvasive; however, many women are not candidates for VH secondary tolarge uterus, previous surgery, and presence of adhesions. Unlessmedical indications require TAH (such as in the case of tumor removaland the associated need to avoid cell spillage), vaginal, TLH and LAVHare usually viewed as more preferable because each is less invasive whencompared to major abdominal surgery. Thus, TLH and LAVH approachesusually result in shorter hospitalization and recovery times. With moreadvance instrumentation and better training of the gynecologic surgeons,the number of hysterectomies is expected to grow ever higher.

Difficulty, however, is encountered when employing TLH and LAVHtechniques due to inherent limitations on visibility, anatomicalidentification, and the ability to manipulate organs (especially theuterus). In the case of TLH, these limitations are particularlypronounced because of higher degree of difficulty in securing theuterine arteries and cardinal ligaments associated with this approach.Altogether, TLH becomes a longer procedure, increasing intraoperativecomplications risks. During TLH, separation of the uterus and the cervixfrom the vagina remains one of the most difficult and cumbersome stepsof the procedure. A higher degree of surgical difficulty has been foundempirically to give rise to an increased risk of inadvertent damage toor dissection into the bladder, ureters, uterine vessels, anduterosacral and cardinal ligaments during the surgical procedure.Although the risk of inadvertent damage, for example, to the ureters canbe minimized by the insertion of ureteral stints and/or peritonealdissection to delineate ureter location, such techniques increase thecomplexity and the cost of the hysterectomy, and was not found to beeffective.

A number of instruments have been developed to assist the physician invisualizing the uterus and facilitating the performance of these variousexaminations and procedures. Typical of these prior art instruments arethose which are described in U.S. Pat. No. 3,926,192 to Van Maren; U.S.Pat. No. 4,000,743 to Weaver; U.S. Pat. No. 4,976,717 to Boyle; and U.S.Pat. No. 4,997,419 to Lakatos et al. The patent to Van Maren is directedto a medical instrument that is inserted into the vagina and passesthrough the cervix to enter the uterus. A cup-shaped member is providedwhose end wall is connected to a source of vacuum, the cup-shaped memberincluding a conical element designed to be placed against the cervicalos. The patent to Weaver describes a uterine anteverter that includes anarcuately curved shield, which limits the distance a manipulating armcan be extended into the uterine cavity.

U.S. Pat. No. 5,209,754 to Ahluwalia describes a vaginal cervicalretractor used to maneuver and visualize the uterus during variousmedical examinations and procedures. The Ahluwalia device has beencommercialized by ConMed Corporation under the title Vcare for theVaginal-Cervical Ahluwalia Retractor-Elevator.

Available instruments, however, do not address the issue of difficultand time-consuming separation of the uterus and the cervix from thevagina during total laparoscopic hysterectomy. Accordingly, there is areal and unsatisfied need in the surgical arts for a simplified totallaparoscopic hysterectomy device that can reduce the time of thesurgical procedure, minimize blood loss during surgery, minimize therisk of infection and injury to the patient during surgery, and minimizeanesthesia time.

DISCLOSURE OF INVENTION

Accordingly, it is an object of the present invention to provide asurgical device that avoids the disadvantages of the prior art.Specifically, it is an object of the present invention to provide acombination uterine manipulator and electrosurgical element that avoidsthe disadvantages of the prior art.

It is an object of the present invention to provide an improvement toexisting uterine manipulators. A related object of the present inventionis to incorporate a retractable monopolar electrode needle into auterine manipulator.

It is another object of the present invention to provide a surgicaldevice that enables improved surgical control of the operating field. Arelated object of the present invention is to facilitate increasedpatient safety by minimizing surgical manipulation. A further relatedobject is to reduce the cost of a total laparoscopic hysterectomy byeliminating the need for multiple surgical instruments and minimizeanesthesia time.

These and other objects of the present invention are accomplished byenabling a device that can perform a total laparoscopic hysterectomy andcolpotomy while maintaining pneumoperitoneum. The device of the presentinvention will allow a surgeon to manipulate the uterus whilesimultaneously performing colpotomy during total laparoscopichysterectomy. By utilizing a vaginal cervical retractor elevatorprovided with an inner rigid tubing, inner and outer cups designed tomove on the inner tubing, a hollow, plastic outer shaft into which theinner tubing can be inserted, and a retractable, flexible,electrosurgical needle, the colpotomy procedure can be performed withthe improved uterine manipulator.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other features, aspects, and advantages of the presentinvention are considered in more detail, in relation to the followingdescription of embodiments thereof shown in the accompanying drawings,in which:

FIG. 1 is a side elevational view of a combination uterine manipulatorand electrosurgical element according to an embodiment of the presentinvention.

FIG. 2 is an enlarged cross-sectional view taken along lines 2-2 of FIG.1.

FIG. 3 is a partial section view of the surgical device, in use,according to an embodiment of the present invention.

FIG. 4 is a front elevational view of a locking and tightening collar ofthe surgical device according to an embodiment of the present invention.

FIG. 5 is a side elevational view of the locking and tightening collarof the surgical device according to an embodiment of the presentinvention.

FIG. 6 is a rear elevational view of a locking and tightening collaraccording to an embodiment of the present invention.

FIG. 7 is a cross-sectional view taken along lines 7-7 of FIG. 4.

BEST MODE(S) FOR CARRYING OUT THE INVENTION

The invention summarized above may be better understood by referring tothe following description, which should be read in conjunction with theaccompanying drawings. This description of an embodiment, set out belowto enable one to build and use an implementation of the invention, isnot intended to limit the invention, but to serve as a particularexample thereof. Those skilled in the art should appreciate that theymay readily use the conception and specific embodiments disclosed as abasis for modifying or designing other methods and systems for carryingout the same purposes of the present invention. Those skilled in the artshould also realize that such equivalent assemblies do not depart fromthe spirit and scope of the invention in its broadest form.

The present invention is an improvement of a pre-existing uterinemanipulator. The improvement involves the addition of a retractableelectrosurgical needle into the uterine manipulator.

Referring to the drawings, FIGS. 1 and 2 show the improved surgicalinstrument, indicated generally as 10, according to the presentinvention. The surgical instrument 10 includes a rigid manipulationshaft 14, which is used as a central assembly axis upon which the partsof the surgical instrument 10 are centered. A cervical cup 12 is moldedto a manipulator tube 18 that surrounds the manipulation shaft 14. Thecervical cup 12 and manipulator tube 18 act as one-piece for passage ofa retractable electrosurgical needle 26 and monopolar electrode 27through a tunnel 28. The manipulator tube 18 is slightly thickened andprovides electrical insulation for the monopolar electrode 27. In apreferred embodiment, the tunnel 28 presents approximately 2 mmclearance. The manipulation shaft 14 typically comprises a metal alloycovered by a non-conductive sheath. The sheath is normally plastic. Onthe distal end of the manipulation shaft 14 is an inflatable balloon 22to stabilize the manipulator tube 18 within the uterine cavity.

The manipulator tube 18 is sized and configured to conform to the sacralcurve and is used for positioning the cervical cup 12 and the vaginalocclusion cup 16 during insertion of the surgical instrument 10. Thecervical cup 12 is provided with a funnel-like base having a taperedbody approximately 20 mm in length with a maximum diameter ofapproximately 40 mm. The cervical cup 12 displaces the cervix 32 awayfrom the ureters, retracts the urinary bladder, and defines thecolpotomy incision. Also mounted on the manipulator tube 18 is a vaginalocclusion cup 16, which includes a hole therein, allowing the uterinemanipulator tube 18 to be inserted therethrough such that the vaginalocclusion cup 16 freely rotates and slides around the manipulator tube18. The vaginal occlusion cup 16 has a tapered body approximately 25 mmin length with a maximum diameter of approximately 40 mm. The vaginalocclusion cup 16 prevents loss of pneumoperitoneum. When the surgicalinstrument 10 is inserted into the vagina 24, the cervical cup 12surrounds and supports the cervix 32 and the vaginal occlusion cup 16stretches the upper vaginal canal, allowing the manipulator tube 18 toperform its particular procedure.

Referring to FIG. 3, the surgical instrument 10 can be inserted into thevagina 24 so that the cervical cup 12 surrounds the cervix 32 and atleast a portion of the uterus 30. The vaginal occlusion cup 16 make anairtight seal in the vagina 24 to maintain pneumoperitoneum when acircumferential colpotomy is completed. The balloon 22 is insertedinside the uterine cavity and is inflated to stay in place in the uterus30 by injecting air into the balloon 22, as is know in the art. Once themanipulator tube 18 and cervical cup 12 are engaged, the assembly can belocked in place on the manipulation shaft 14 using thumbscrew 38, untilsuch time that a colpotomy needs to be performed.

The flexible electrosurgical needle 26 and monopolar electrode 27 arehoused inside the tunnel 28 that traverses the manipulator tube 18. Theelectrosurgical needle 26 remains in the tunnel 28 until the surgeon isready to use it. The proximal end of the monopolar electrode 27 isattached to a standard operating room electrosurgical generator by meansof a standard monopolar cord. The attachment point of the monopolar cordto the electrode 27 is located at the proximal end of a locking collar20, as shown in FIG. 4. The locking collar 20 is used to advance and fixin place the electrosurgical needle 26. The locking collar 20 freelyslides and rotates on the manipulation shaft 14, together with themanipulation tube 18 and cervical cup 12.

FIGS. 4-7 show the locking and tightening collar for the surgicalinstrument 10. The locking collar 20 includes a cogwheel front outerportion 20 a, which is shaped for easy handling and rotation by the handof a surgeon, and a rear star-shaped outer portion 20 b. The diameter ofthe proximal end 19 of the manipulator tube 18 is slightly enlarged andhollowed to enable the star-shaped portion 20 b to be engaged therein.The electrosurgical needle 26 is retracted and housed inside themanipulator tube 18 and cervical cup 12 by means of pulling on thelocking collar 20 until ready to be engaged.

After completing all other necessary steps of the surgical procedure,the surgeon must be ready to perform a colpotomy, the separation of theuterus 30 and cervix 32 from the vagina 24. With the surgical instrument10 in place, the electrosurgical needle 26 is advanced through thevaginal-cervical junction 36 into the pelvic cavity 34, under directlaparoscopic vision, by means of advancing the locking collar 20. Thestar-shaped portion 20 b of the locking collar 20 is engaged into acorrespondingly shaped receiving well 25 on the proximal end 19 of themanipulator tube 18. In a preferred embodiment, the receiving well 25 isapproximately 25 mm deep and is sized and configured to receive thesimilarly sized star-shaped portion 20 b of the locking collar 20. Thestar-shaped portion 20 b fixes the assembly of the collar 20 within themanipulator tube 18 and provides rotational torque to the manipulatortube 18, cervical cup 12, and electrosurgical needle 26. The sharp pointof the electrosurgical needle 26 punctures the tissue at thevaginal-cervical junction 36. The advancement of the electrosurgicalneedle 26 will be achieved by the cephalad sliding motion of theelectrosurgical needle 26 and monopolar electrode 27 within theprotective tunnel 28.

The monopolar electrode 27 is activated so that the electrosurgicalneedle 26 can then be rotated around the rigid manipulation shaft 14 asindicated by arrow 40. With the star-shaped portion 20 b locked inplace, rotating the cogwheel 20 a results in electrosurgical separationof the uterus 30 and cervix 32 from the vagina 24. By utilizing theprinciples of electrosurgery applied to the monopolar electrosurgicalneedle 26, the separation of the uterus 30 and cervix 32 from the vagina24 is performed by electric current passing through the monopolarelectrode 27 and electrosurgical needle 26 while the surgical instrumentis rotated in a circular pattern around the vaginal-cervical junction36.

The invention has been described with references to a preferredembodiment. While specific values, relationships, materials and stepshave been set forth for purposes of describing concepts of theinvention, it will be appreciated by persons skilled in the art thatnumerous variations and/or modifications may be made to the invention asshown in the specific embodiments without departing from the spirit orscope of the basic concepts and operating principles of the invention asbroadly described. It should be recognized that, in the light of theabove teachings, those skilled in the art can modify those specificswithout departing from the invention taught herein. Having now fully setforth the preferred embodiments and certain modifications of the conceptunderlying the present invention, various other embodiments as well ascertain variations and modifications of the embodiments herein shown anddescribed will obviously occur to those skilled in the art upon becomingfamiliar with such underlying concept. It is intended to include allsuch modifications, alternatives and other embodiments insofar as theycome within the scope of the appended claims or equivalents thereof. Itshould be understood, therefore, that the invention may be practicedotherwise than as specifically set forth herein. Consequently, thepresent embodiments are to be considered in all respects as illustrativeand not restrictive.

INDUSTRIAL APPLICABILITY

The present invention is applicable to surgical instruments. Theinvention discloses a colpotomy assembly having an electrosurgicalneedle retractably mounted therein. The device can be made in industryand can be used in the medical field.

What is claimed is:
 1. A colpotomy assembly adapted for insertion into avaginal cavity for use in female pelvic surgical procedures comprising:a rigid elongated inner tube having a distal end and a proximal end; anelongated outer tube having a distal end and a proximal end surroundingsaid inner tube, said elongated outer tube being free to slide androtate on said inner tube; an outer cervical cup having a top portion ofa first diameter and a bottom portion having a second diameter less thansaid first diameter, said bottom portion of said outer cup provided witha hole therein, said outer cup being joined to the distal end of saidelongated outer tube; an inner occlusion cup having a top portion of athird diameter and a bottom portion having a fourth diameter less thansaid third diameter, said bottom portion of said inner cup provided witha hole therein, said inner cup being free to slide and rotate on saidelongated outer tube; and an electrosurgical needle retractably mountedin said outer cervical cup; wherein when said device is utilized, saidinner cup would surround and support the cervix and said outer cup wouldstretch the upper vaginal canal, and wherein said electro surgicalneedle would puncture the vaginal-cervical junction to separate theuterus and cervix from the vagina.
 2. The colpotomy assembly accordingto claim 1, said outer tube further including a tunnel having amonopolar electrode portion of said electrosurgical needle therein. 3.The colpotomy assembly according to claim 2, wherein said tunnel iselectrically insulated.
 4. The colpotomy assembly according to claim 1,said inner tube comprising a metal alloy and wherein said inner tubeincludes a non-conductive sheath to electrically insulate said innertube.
 5. The colpotomy assembly according to claim 1, wherein the distalend of said inner tube is provided with a balloon.
 6. The colpotomyassembly according to claim 1 further comprising a locking collarsurrounding said inner tube and removably attached to said outer tube,said locking collar being free to slide and rotate on said elongatedinner tube.
 7. The colpotomy assembly according to claim 6, said lockingcollar comprising a front outer portion and a rear outer portion, saidfront outer portion being configured for handling and rotation, and saidrear outer portion being configured for engagement with the proximal endof said outer tube.
 8. The colpotomy assembly according to claim 7,wherein the proximal end of said outer tube is configured for engagementwith the rear portion of said locking collar.
 9. A colpotomy assemblyadapted for insertion into a vaginal cavity for use in female pelvicsurgical procedures employing the inflation of an abdominal cavity witha gas to facilitate the accessibility to and visibility of female pelvicorgans, said assembly comprising: an elongated shaft member presenting aproximal end and a distal end, said distal end of said shaft configuredto be inserted into the vagina; an elongated outer tube having a distalend and a proximal end surrounding said elongated shaft member, saidelongated outer tube being free to slide and rotate on said elongatedshaft member; a handle mounted to said proximal end of said elongatedouter tube; an outer cervical cup joined to the distal end of saidelongated outer tube; an inner occlusion cup having a hole therein, saidinner cup being free to slide and rotate on said elongated outer tube;and an electrosurgical needle retractably mounted in said outer cervicalcup.
 10. The colpotomy assembly according to claim 9, further comprisinga balloon mounted to said distal end of said shaft, configured to engagea uterus.
 11. The colpotomy assembly according to claim 9, said outertube further including a tunnel having a monopolar electrode portion ofsaid electrosurgical needle therein.
 12. The colpotomy assemblyaccording to claim 11, wherein said tunnel is electrically insulated.13. The colpotomy assembly according to claim 9, said elongated shaftmember comprising a metal alloy having a non-conductive sheath toelectrically insulate said elongated shaft member.
 14. The colpotomyassembly according to claim 9, said handle further comprising a lockingcollar surrounding said elongated shaft member and removably attached tosaid outer tube, said locking collar being free to slide and rotate onsaid elongated shaft member.
 15. The colpotomy assembly according toclaim 14, said locking collar comprising a front outer portion and arear outer portion, said front outer portion being configured forhandling and rotation, and said rear outer portion being configured forengagement with the proximal end of said outer tube.
 16. The colpotomyassembly according to claim 14, wherein the proximal end of said outertube is configured for engagement with the rear portion of said lockingcollar.